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Russian health reform: strategy is right but tactic sometimes fails

March 24, 2015, 17:32 UTC+3 Alexandrova Lyudmila
© ITAR-TASS/Dmitriy Rogulin

MOSCOW, March 24. /TASS/. Russia’s health reform, in the first place, the way it is being implemented in Moscow, is tough-going and has drawn criticism from some medics and the population. Its officially declared purpose is to upgrade health service establishments and provide better services to the patients, but at the same time it envisages the closure of some hospitals, merger of others and a major cut in medical personnel. According to official statistics, 8,300 medical workers had been dismissed in Moscow by last February. The remaining personnel were told to service more patients, and the average time a doctor spends on one visitor has been cut to 9-10 minutes.

The strategy that has been chosen is a correct one and the reform will eventually yield positive results, but the methods the local authorities sometimes choose leave much to be desired, experts say.

Medics at Moscow’s six outpatient clinics on Tuesday warned they might launch a work-to-rule action to protest the way Moscow’s health service is being reformed. But, as the Moscow authorities have said, the attempt failed. It is a hard fact, though, that the campaign to optimize Moscow’s health service, started in the middle of last year, has drawn mass discontent. Last year Moscow’s medics staged several protest actions.

Moscow’s deputy mayor for social development, Leonid Pechatnikov, has confirmed that massive cuts are inevitable, but he promised that all specialists will be able to undergo retraining at the government expense and granted new jobs. And Moscow’s Mayor Sergey Sobyanin promised lump sum bonuses to the medics whose jobs have been axed - from 200,000 roubles (3,300 US dollars) to 500,000 roubles (8,300 dollars).

Some federal officials, too, have criticized the Moscow authorities for the way the reform has been proceeding. The head of the State Duma’s health protection committee, Sergey Kalashnikov, has said that "reforms in Moscow are appalling" and that "the availability of medical assistance has shrunk drastically."

"I believe that our colleagues have failed to give proper thought to it and to foresee every detail," President Vladimir Putin said last November. "While being guided by right considerations and fine intentions by and large they could have arranged for this quite differently. We have already discussed this theme with the Moscow authorities."

"In all regions the health service reform situation is different," the deputy director of the Social Analysis and Forecasting Institute at the presidential academy RANEPA, Vladimir Nazarov, has told TASS. "Moscow has paid no attention to reforming its health service for too long. The city has excessive health service capacities, but it has to be remembered that it services not just Moscow alone, but the whole country."

The presidential decrees of May 2012 required a rise in the medical workers’ salaries, but there was no way of meeting the target while leaving the number of medical personnel unchanged, Nazarov said. Therefore the Moscow government launched an optimization campaign, but the way it has chosen has proved too radical: literal axing of medical workers’ jobs and health service establishments without any attempts to try to meet the interests of the patients."

Nazarov welcomes some of the Moscow authorities’ projects, but on the whole "very crude, administrative methods" have gained the upper hand there where financial incentives should have been established to let the system reorganize itself.

"The idea was right, but the selected methods were not the very best ones," he said.

The reform envisages three directions - restructuring of medical assistance, standards of providing it and the related revision of approach to personnel placement and, lastly, improvement of the remuneration system," says the chief of the economics and social sphere management chair at the RANEPA academy, Larisa Gabuyeva. "These three vectors should have been employed successively, but many regions have fallen behind and the new approach to remuneration was introduced before the first two stages were over. Both medical personnel and patients were strongly hit. It has turned out that the reform has brought about negative effects. There would have been nothing of the sort, if the regional authorities were acting on time."

"There is one more problem. The administrative bodies of the health service have lost the financial support functions. All finance issues were handed over to the medical insurance system. As it has turned out, some set the rules, while others are to provide the money," Gabuyeva said. At the same time she has no doubts "the reform proceeds in the right direction."

"At this moment every effort should be focused on minimizing or avoiding negative effects," she said.


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